Supplementary Data — N-acetylcysteine reduces COVID-19 risk: real-time meta analysis of 24 studies

@CovidAnalysis, December 2025, Version 2V2
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Altay (DB RCT) 80% 0.20 [0.01-4.85] hosp. 0/229 1/76 CT​1​ Improvement, RR [CI] Treatment Control Altay (DB RCT) 83% 0.17 [0.13-0.24] no recov. 229 (n) 75 (n) CT​1​ Ignatova 20% 0.80 [0.64-1.00] hosp. time 56 (n) 55 (n) de Alencar (DB RCT) -3% 1.03 [0.41-2.27] death 9/67 9/68 de Alencar (DB RCT) -16% 1.16 [0.59-2.01] ventilation 16/67 14/68 de Alencar (DB RCT) 9% 0.91 [0.59-1.28] ICU 29/67 32/68 de Alencar (DB RCT) -12% 1.12 [0.77-1.65] ICU 67 (n) 68 (n) de Alencar (DB RCT) -10% 1.10 [0.37-3.23] hosp. time 67 (n) 68 (n) Gaynitdinova (RCT) 15% 0.85 [0.77-0.93] hosp. time 24 (n) 22 (n) Gaynitdinova (RCT) 51% 0.49 [0.32-0.75] Ct imp. 24 (n) 22 (n) Pellegrini 52% 0.48 [0.33-0.70] death 138 (n) 726 (n) Pourhoseingholi 11% 0.89 [0.68-1.18] death 65/309 274/2,159 Taher (DB RCT) 18% 0.82 [0.43-1.58] death 12/47 14/45 Taher (DB RCT) 14% 0.86 [0.53-1.40] ventilation 18/47 20/45 Taher (DB RCT) 20% 0.80 [0.44-1.47] ICU 47 (n) 45 (n) Taher (DB RCT) 33% 0.67 [0.31-1.45] hosp. time 47 (n) 45 (n) Taher (DB RCT) 15% 0.85 [0.60-1.22] no recov. 25/47 28/45 Assimakopoulos 97% 0.03 [0.00-0.30] death 2/42 12/40 Avdeev 69% 0.31 [0.03-2.72] death 1/24 3/22 Avdeev 77% 0.23 [0.03-1.90] ventilation 1/24 4/22 Avdeev 77% 0.23 [0.03-1.90] ICU 1/24 4/22 Avdeev 15% 0.85 [0.75-0.96] hosp. time 24 (n) 22 (n) STORM Faverio (PSW) -19% 1.19 [0.85-1.66] death 91/572 44/329 STORM Faverio (PSW) -34% 1.34 [0.97-1.84] ICU 107/572 46/329 STORM Faverio (PSW) 1% 0.99 [0.81-1.20] no disch. 180/572 105/329 Ramadhan -135% 2.35 [0.33-16.9] death 11/75 1/16 Izquierdo 26% 0.74 [0.63-0.88] death 136/2,071 1,935/17,137 Delić (RCT) 14% 0.86 [0.64-1.17] death 24/39 37/52 Intubated patients Delić (RCT) 10% 0.90 [0.63-1.30] death 21/39 31/52 Intubated patients Fariña-González 39% 0.61 [0.34-1.09] death 10/38 44/102 Intubated patients Mousapour (DB RCT) 2% 0.98 [0.26-3.64] death 4/42 4/41 Mousapour (DB RCT) 27% 0.73 [0.28-1.93] ventilation 6/42 8/41 Mousapour (DB RCT) 6% 0.94 [0.67-1.32] no improv. 25/42 26/41 Mousapour (DB RCT) 5% 0.95 [0.74-1.21] no disch. 31/42 32/41 Rahimi (SB RCT) 33% 0.67 [0.40-1.11] death 10/20 15/20 ICU patients Rahimi (SB RCT) 8% 0.92 [0.68-1.26] hosp. time 20 (n) 20 (n) ICU patients Çavuş (ICU) -13% 1.13 [0.85-1.50] death 52/97 44/93 ICU patients Çavuş (ICU) -20% 1.20 [0.91-1.58] ventilation 55/97 44/93 ICU patients Çavuş (ICU) 12% 0.88 [0.55-1.39] ICU 97 (n) 93 (n) ICU patients Çavuş (ICU) 13% 0.87 [0.74-1.02] hosp. time 97 (n) 93 (n) ICU patients Panahi (RCT) 92% 0.08 [0.03-0.22] death 4/125 49/125 Inhaled Panahi (RCT) 36% 0.64 [0.29-1.43] ICU 9/125 14/125 Inhaled Panahi (RCT) 1% 0.99 [0.94-1.05] hosp. time 125 (n) 125 (n) Inhaled Gamarra-Mo.. (RCT) 16% 0.84 [0.55-1.29] death 25/72 28/68 ICU patients Afaghi 29% 0.71 [0.33-1.52] death 10/217 16/245 Afaghi 41% 0.59 [0.30-1.16] ventilation 12/217 23/245 Afaghi 20% 0.80 [0.51-1.24] ICU 29/217 41/245 Afaghi 14% 0.86 [0.79-0.95] hosp. time 217 (n) 245 (n) Sherkawy (RCT) 0% 1.00 [0.07-15.3] death 1/30 1/30 Sherkawy (RCT) 15% 0.85 [0.57-1.27] oxygen 17/30 20/30 Sherkawy (RCT) 33% 0.67 [0.50-0.88] oxygen time 30 (n) 30 (n) Sherkawy (RCT) 12% 0.88 [0.62-1.23] hosp. time 30 (n) 30 (n) Galindo-Andúgar 43% 0.57 [0.31-0.99] death 199 (n) 179 (n) Atefi (SB RCT) 67% 0.33 [0.04-3.03] death 1/30 3/30 Huh 28% 0.72 [0.66-0.79] cases case control N-acetylcysteine COVID-19 outcomes c19early.org December 2025 ​1​ CT: study uses combined treatment Favors N-acetylcysteine Favors control
Fig. S1. All outcomes.
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Fig. S2. Comparison of results for RCTs versus observational studies. For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.